************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************

1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Rockvale
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  2966
Registered No:  
2. FULL NAME:  Wheatley, Leafy
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  Feb. 12, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  Stillborn
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co., KY
10. NAME OF FATHER:  Angus Lee Wheatley
11. BIRTHPLACE OF FATHER:  Breckinridge Co., KY
12. MAIDEN NAME OF MOTHER:  Ena Frances Duncan
13. BIRTHPLACE OF MOTHER:  Grayson Co., KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mizzas Wheatley
(Address)  Unreadable
15. Filed  Feb. 12, 1911
REGISTAR:  E . L. Robertson
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Feb. 12, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feb. 12, 1911
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  11:15 AM
THE CAUSE OF DEATH was as follows:  Stillborn

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. B. Lampton
Date:  
Address:  McDaniels, KY
18. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19. PLACE OF BURIAL OR REMOVAL:  Unreadable
DATE OF BURIAL:  
20. UNDERTAKER:  Unreadable
ADDRESS:  

************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************